Kneisl J S, Sweeney H J, Paige M L
Evanston Hospital, Illinois.
Arthroscopy. 1988;4(1):21-4. doi: 10.1016/s0749-8063(88)80006-9.
Correlation of double contrast arthrotomography (DCAT) of the shoulder and arthroscopic surgery diagnostic results have been undertaken in 55 patients with persistent shoulder pain or involuntary shoulder instability. During the period March 1984 to December 1986, 55 patients underwent DCAT followed by videotaped diagnostic shoulder arthroscopy. The primary indication for DCAT was persistent pain in 36 patients and instability in 17 patients. DCAT was performed according to the method of El-Khoury and Albright, and all arthroscopies were performed in a similar fashion by the senior author (HJS). Both tests were reviewed separately, retrospectively, and their results were correlated. For combined (anterior and posterior) labral pathology, the sensitivity/specificity for the instability group was 0.91/0.91, respectively; sensitivity/specificity for the pain group was 0.63/0.94. DCAT accurately depicted the status of 76% of anterior labrums and 96% of posterior labrums. For complete rotator cuff tears, sensitivity/specificity was 1.0/0.94. The status of a complete rotator cuff tear was accurately depicted in 91% of patients. Partial rotator cuff tears were missed in 83% of patients by DCAT. The presence or absence of loose bodies was accurately represented by 96% of DCAT. Arthroscopy showed that 71% of the instability patients had a labral tear, compared with 44% of the pain patients. Rotator cuff pathology was present in 12% of instability patients and 42% of pain patients. These findings indicate that DCAT may be a conditionally reliable test in the diagnosis of shoulder instability. DCAT must be considered inconclusive, however, in the painful shoulder without instability. Its usefulness as a preoperative screening test is discussed, and a diagnostic algorithm is presented. DCAT does not equal the diagnostic accuracy of shoulder arthroscopy.
对55例持续性肩部疼痛或肩部非自主性不稳定患者进行了肩部双重对比关节造影（DCAT）与关节镜手术诊断结果的相关性研究。在1984年3月至1986年12月期间，55例患者先接受了DCAT检查，随后进行了肩部诊断性关节镜录像检查。DCAT的主要适应证为36例持续性疼痛患者和17例不稳定患者。DCAT按照El-Khoury和Albright的方法进行，所有关节镜检查均由资深作者（HJS）以类似方式进行。两项检查分别进行回顾性评估，并对结果进行相关性分析。对于合并（前侧和后侧）盂唇病变，不稳定组的敏感度/特异度分别为0.91/0.91；疼痛组的敏感度/特异度为0.63/0.94。DCAT准确描绘了76%的前盂唇和96%的后盂唇状况。对于完全性肩袖撕裂，敏感度/特异度为1.0/0.94。91%的患者中完全性肩袖撕裂的状况被准确描绘。DCAT漏诊了83%患者的部分性肩袖撕裂。96%的DCAT准确显示了游离体的存在与否。关节镜检查显示，71%的不稳定患者存在盂唇撕裂，而疼痛患者中这一比例为44%。12%的不稳定患者和42%的疼痛患者存在肩袖病变。这些发现表明，DCAT在诊断肩部不稳定方面可能是一种有条件可靠的检查方法。然而，对于无不稳定的疼痛性肩部，DCAT必须被认为是不确定的。讨论了其作为术前筛查检查的实用性，并给出了诊断算法。DCAT的诊断准确性不及肩部关节镜检查。
